Thai physicians’ perceptions of sources of information about new drugs in terms of amounts of information and trustworthiness.

Objective: To determine Thai physicians’ opinions of sources of information about new drugs regarding amounts of information and the trustworthiness of the sources. Methods: Questionnaires developed by the research team were sent to physicians working at each regional/general hospital (92 totals) of the Ministry of Public Health in Thailand asking them to indicate the amount of information about new drugs from different sources and the trustworthiness of the sources. Multiple regression analysis was used to determine variables that related to the trustworthiness of information sources. Results: One hundred and thirty (28.26%) of 460 questionnaires were returned. These indicated that in terms of amounts of new information, Thai physicians received most from academic conferences, followed by medical journals, and medical representatives respectively. Information from conferences was considered to be most trustworthy followed by information from medical schools and experts. In contrast, information from medical representatives, direct mail advertisements, and hospital pharmacists had low trustworthiness. After controlling for the variables of gender, education, and type of hospital, multiple regression analysis found that the only significant factor was the relationship between age and trustworthiness of information from the source of medical journals (standardized β = 0.199, p = 0.039). There was no factor that significantly related to trustworthiness of information from other sources. Conclusion: Thai physicians received information about new drugs from both commercial and professional sources but trusted information from the latter more. This was considered appropriate as studies had found that information from commercial sources was sometimes inaccurate, incomplete and misleading.

The mortality risks of pneumonia patients with the same levels of health insurance coverage in Thailand before and after the implementation of the universal care project.

Objective: To compare the mortality risks of pneumonia patients with the same levels of health insurance coverage status before and after the implementation of the Universal Health Care Coverage Project (UC). Methods: A retrospective cohort study was conducted. The sample was pneumonia patients admitted to hospitals owned by the Ministry of Public Health (MOPH) of Thailand during 2001-2002. Logistic regression analysis was used to determine whether mortality risks of pneumonia patients with the same levels of health insurance coverage status before and after the implementation of the UC were different after controlling for important variables. Results: Of the 8,577,482 patients admitted to the Thai Ministry of Public Health Hospitals during 2001-2002, there were 112,205 and 115,386 patients diagnosed with a type of pneumonia in 2001 and 2002, respectively. After controlling for sex, age, marital status, hospital type and length of stay, patients admitted after the implementation of the UC who were insured or had UC with 30 baht co-payment coverage had no significant difference in mortality risks (OR = 1.08, P = 0.20; OR = 1.03, p = 0.62; respectively). In contrast, patients who were under the UC without co-payment had higher mortality risk after the implementation of the UC (OR = 1.12, P = 0.001). Conclusion: Before and after the implementation of the UC project, pneumonia patients who had the same levels of health insurance coverage had differences mortality risks regarding to their health insurance coverage status. Whether the results reflected the impact of the UC project, unmeasured differences in quality of care, restricted access to care, or differences in co-morbidities remains to be determined.

Differences in information provided between thai and international advertisements of the same drugs.

The purpose of this study was to compare differences of information provided in Thai drug advertisements (ads) and foreign drug ads. The advertisements included in the study had to have the same generic name in both Thai and foreign ads. Twenty Thai ads were collected from medical companies, hospitals and Thai medical journals. Twenty foreign ads were collected from foreign medical journals such as The Lancet and JAMA published during 2000-2003. Results showed that there were 5 criterion that the same proportion of Thai and foreign Ads provided information: brand name (100%), indication (95%), initial dose (30%), duration of therapy (30%), and the manufacture or importer name (95%). However, there were 9 criteria by which Thai ads provided less information than foreign ads, but there was no statistical significance. The criteria were generic name, formula, adverse drug reaction, contraindication, precaution, package size, legal category, reference and price. The only criterion by which Thai ads provided significantly less information than foreign ads was information on drug interaction (30% vs. 65%; p = 0.028). In addition, there were 3 criteria by which Thai ads provided more information than foreign ads, but were not significant. The information was the pharmacological group of drugs, standard dose and stability. However, there were 3 criteria by which Thai ads provided significantly more information than foreign ads: dosage form (70% vs. 50%; p = 0.046), storage (95% vs. 70%; p = 0.046) and administration (25% vs. 0%; p = 0.024). In addition the results showed that most Thai and foreign ads used the alphabet size of 3 mm or more to describe the information on brand name, generic name and indication. However, they used the alphabet size of less than 3 mm to describe the information on formula, standard dose, initial dose, adverse drug reaction, contraindication, precaution, duration of therapy, storage, package size, legal category, administration, drug interaction and reference. Results from the study indicated that there are double standards of information provided in Thai and foreign ads even though the drugs had the same generic names and were manufactured by the same company. Health personnel should use other sources of information, in addition to the information from the ads, to prescribe drugs.

Stress and coping behavior of out-patients in yasothon province.

Objective: Due to current lifestyles that forces people to struggle their lives, we are going to a stage of mind control problems which can lead to stressful conditions. This can cause health and mind problems which contribute to a crime, sadness, loneliness, hopelessness, etc. In addition, types of health services play a major role in stress conditions which may be caused by internal and external factors affecting the patients. Methods: The study aimed to assess the relationship between stress levels and personnel characteristics, especially the evaluation of stress levels in relationship to different health services and other factors. A total of 809 outpatients visited different health care services (e.g., governmental hospital, private hospitals, health care centres, etc) at Yasothon. They were asked to collaborate on this project by filling out a questionnaire survey. The contents of a survey related to volunteers’ feeling and stress coping behaviors over the last 2 months after visitng different health care services. This project was conducted from March to June in 2003. The data were analyzed by using SPSS which included; 1) frequency, 2) percentage, 3) mean, 4) standard deviation (S.D.), 5) t-test, 6) Chi-square, 7) Correlation and 8) One-way ANOVA. Results: The results revealed that most of volunteers had normal stress level (43.1%). When compared between stress levels and the characteristics of economic and social status, we found that gender was not related to statistically significant difference (p>0.05) in stress level. However, other factors including age, education, occupation, and income, related to stress levels were statistically and significant difference (p<0 .05). The elderly people had higher levels of stress than middle aged groups. Moreover, different occupations had different levels of stress; farmers had a highest level. People with a higher income had more stress than those with a lower income. Similarly, those who had illnesses had more stress than those who did not have illnesses (p =0.001). Levels of health care services also affected the stress levels; those admitted to private hospital had less stress than those admitted to governmental hospitals. The major causes of stress can be divided into 2 categories: 1) salary status, and 2) health/conflict/personal issues. The main solutions of stress included; 1) finding the causes and solving the problems, 2) entertaining themselves, etc. People who could possibly help stress victims included; lovers, spouses, teachers, and friends. Conclusion: There is a relation between stress levels and other factors, including: gender, age, educational status, marital status, income, etc. In addition, there are some major causes of stress such as salary, personal issues, and health which can eventually lead to some metal problems. The author suggests that further study should concentrate on wider areas, and not just only Yasothon Province, in order to see the overall picture of stressful situations. The methods of assessing stress levels should be modified in different ways such as creating a standard mental status tool, or introducing control-study groups. Also, attitude sharing should be conducted within the volunteer group in order to exchange ideas regarding stressful conditions. Thus, the data received will be more adequate and complete. Finally, some external factors which were not able to be controlled in this study might have effected the results. Therefore, we should limit those factors for the next study.

Usage of and cost of complementary/alternative medicine in diabetic patients.

The purposes of the present survey research in diabetic patients were 1) to determine characteristics of complementary/alternative medicine (CAM) use, 2) to identify factors related to CAM use such as sociodemographic, adverse effects, and quality of life, and 3) to determine differences between patients who used and did not use CAM. The data was collected through developed questionnaires and SF-36 scale Thai version. Samples were 159 diabetes patients over 18 years of age or older who came for treatment at Suppasitthiprasong Hospital, Ubon Ratchathani Province, Thailand. The results indicated that the prevalence of CAM use was rather high (47.8%). The most common types of CAM used were yoga/exercise (32.8%), unchanged form of herbal medicine (29.9%), and changed form herbal medicine (17.8%). The average expense of CAM use was dollar 8.58 per person per month. Thus, if the percentage of CAM use and the cost were true for other Thai diabetic patients throughout Thailand, CAM use expenditure for the whole country would be about dollar 915,250-1,545,750 per month, which is quite high for a small country like Thailand. Most patients (64.4%) who used CAM did not inform their doctors about their CAM use. Results also indicated that government official patients were more likely to use CAM than those of farmer patients significantly (p-value = 0.03, odds ratio = 12.11). In addition, the present study found that patients who had a higher income were more likely to use CAM than those of lower income patients significantly (p - value = 0.04, odds ratio = 1.01). However, other factors such as age, sex, marital status, level of education, health insurance coverage status, duration of time to treat, occurrence of adverse effects, and quality of life were not different between the patients who used CAM and who did not use CAM. Physicians should pay more attention to the CAM use of patients since they used CAM without informing physicians and some herbal medicines may cause hypoglycemia. However, the study results had some limitations to apply to other Thai populations since the sample were Suppasitthiprasong patients who may be different from other Thai populations in many ways such as their local culture, belief, and CAM use types and cost.

Mortality risks of appendicitis patients Who had different levels of health insurance coverage status.

The objective of this retrospective cohort study was to determine the association between mortality risks of appendicitis inpatients with different levels of health insurance coverage status. The subjects were the appendicitis inpatients admitted to the Ministry of Public Health (MOPH) hospitals in the year 2000. The patients’ information (65,233 patients) recorded in the Diagnosis-Related Group (DRG) database of the Thai MOPH was used for this data analyses. After controlling for length of stay, age, sex, hospital type, and marital status, The results showed that patients who were in the low income scheme plan (LIS) had higher mortality risk than those who were insured (OR = 3.38, p = 0.025). However, the mortality risk of patients in the LIS plan and those of patients in other levels of health insurance coverage status (full pay, under MOPH policy, partially pay) were not different.

Usage of alternative medicine in cancer patients.

The purpose of this study was to find out the characteristics of alternative medicine (AM) use and factors related to its use such as expense, compliance, and quality of life in 180 cancer patients from Suppasitthiprasong Hospital and the Center of Cancer Prevention and Control in Ubon Ratchathani. Results from questionnaires indicated that 77% of cancer patients used AM, mostly herbal medicine either in altered or unaltered from, because they received advice from other persons and wanted to obtain extra treatment. Patients who used AM still maintained good compliance with their conventional treatment. However, 51.35% of patients were using both alternative and conventional medicine without telling their doctors. The mean expense for AM us was 451 Baht per patients per month. Thus, if the percentage of AM use and their costs are true for other Thai cancer patients throughout Thailand, AM use expenditure for the whole country would be about 112 millions Baht per month, which is quite high. After controlling for other factors, results also indicated that patients with low education (primary grade or lower) were significantly more likely to use AM than those patients with higher education (high school or higher) (OR = 0.04, p = 0.007). Unemployed patients were significantly more likely to use AM than those patients who were farmers (OR = 0.04, p = 0.007). Patients who suffered from side effects of conventional therapy were significantly more likely to use AM than patients who did not (OR = 3.05, p = 0.005). In addition, patients without problems with daily life due to cancer pain were significantly more likely to use AM than those who had no emotional problems (OR = 0.98, p = 0.004). However, there were no other differences in other dimensions of quality of life. There are some limitations in this study preventing generalization to other Thai people such as the lack of information concerning the patients’ diagnosis and stage of cancer, differences in cultures and belief, and the AM cost.

Mortality risks of pneumonia patients with different levels of health insurance coverage in Thailand.

Objective : To compare mortality risks of pneumonia patients with different levels of health insurance coverage. Design : Retrospective cohort study Sample : Pneumonia patients admitted to hospitals owned by the Ministry of Public Health (MOPH 4) of Thailand in 1999. Results : Of the 3,725,847 patients admitted to the Thai Ministry of Public Health hospitals, 73,560 patients were diagnosed with a type of pneumonia. Patients with differences in the level of health insurance coverage had significantly different mortality risks. Compared to patients under the Thai government Low Income Scheme, patients with higher levels of health insurance coverage were significantly move likely to have lower mortality risks, such as those patients who had the ability to pay their health service cost (OR=.73,p <.00.1), those who were in the civil servant medical benefit plan (OR= .51,p <.001), or those who were under another MOPH health insurance coverage plan such as health volunteers (OR= .48, p = .003) after controlling for age, gender, marital status, hospital types, and length of stay. Conclusion : Pneumonia patients who had lower levels of health insurance coverage had a significantly higher mortality risk than those of insured or self-insured patients. Whether the results reflected unmeasured differences in quality of care, restricted or delayed to access to care, or differences in comorbidites remains to be determined.